Gallstones
National Digestive Diseases Information Clearinghouse
What are gallstones?
Gallstones are hard particles that develop in
the gallbladder. The gallbladder is a small,
pear-shaped organ located in the upper right
abdomen—the area between the chest and
hips—below the liver.
Gallstones can range in size from a grain
of sand to a golf ball. The gallbladder can
develop a single large gallstone, hundreds of
tiny stones, or both small and large stones.
Gallstones can cause sudden pain in the
upper right abdomen. This pain, called a
gallbladder attack or biliary colic, occurs
when gallstones block the ducts of the biliary
tract.
Liver
Gallbladder
The biliary tract
What is the biliary tract?
The biliary tract consists of the gallbladder
and the bile ducts. The bile ducts carry bile
and other digestive enzymes from the liver
and pancreas to the duodenum—the first
part of the small intestine.
The liver produces bile—a fluid that carries
toxins and waste products out of the body
and helps the body digest fats and the
fat-soluble vitamins A, D, E, and K. Bile
mostly consists of cholesterol, bile salts,
and bilirubin. Bilirubin, a reddish-yellow
substance, forms when hemoglobin from red
blood cells breaks down. Most bilirubin is
excreted through bile.
Liver Hepatic ducts
Cystic duct
Gallbladder
Pancreas
Duodenum
Common bile duct
Pancreatic duct
The bile ducts of the biliary tract include
the hepatic ducts, the common bile duct,
Certain people have a higher risk of
the pancreatic duct, and the cystic duct.
developing gallstones than others:2
The gallbladder stores bile. Eating signals
the gallbladder to contract and empty bile
through the cystic duct and common bile
duct into the duodenum to mix with food.
What causes gallstones?
Imbalances in the substances that make up
bile cause gallstones. Gallstones may form
if bile contains too much cholesterol, too
much bilirubin, or not enough bile salts.
Scientists do not fully understand why these
imbalances occur. Gallstones also may form
if the gallbladder does not empty completely
or often enough.
The two types of gallstones are cholesterol
and pigment stones:
• Cholesterol stones, usually yellow-green
in color, consist primarily of hardened
cholesterol. In the United States,
more than 80 percent of gallstones are
cholesterol stones.1
• Pigment stones, dark in color, are made
of bilirubin.
2 Gallstones
Who is at risk for gallstones?
• Women are more likely to develop
gallstones than men. Extra estrogen
can increase cholesterol levels in bile
and decrease gallbladder contractions,
which may cause gallstones to form.
Women may have extra estrogen due
to pregnancy, hormone replacement
therapy, or birth control pills.
• People over age 40 are more likely to
develop gallstones than younger people.
• People with a family history of
gallstones have a higher risk.
• American Indians have genetic factors
that increase the amount of cholesterol
in their bile. In fact, American Indians
have the highest rate of gallstones in
the United States—almost 65 percent
of women and 30 percent of men have
gallstones.
• Mexican Americans are at higher risk of
developing gallstones.
Other factors that affect a person’s risk of • Metabolic syndrome, diabetes, and
gallstones include2 insulin resistance. These conditions
increase the risk of gallstones.
• Obesity. People who are obese, especially
Metabolic syndrome also increases
women, have increased risk of developing
the risk of gallstone complications.
gallstones. Obesity increases the amount
Metabolic syndrome is a group of traits
of cholesterol in bile, which can cause
and medical conditions linked to being
stone formation.
overweight or obese that puts people
• Rapid weight loss. As the body breaks at risk for heart disease and type 2
down fat during prolonged fasting and diabetes.
rapid weight loss, the liver secretes extra
Read more about these conditions in
cholesterol into bile. Rapid weight loss
Insulin Resistance and Prediabetes at
can also prevent the gallbladder from
www.diabetes.niddk.nih.gov.
emptying properly. Low-calorie diets
and bariatric surgery—surgery that Pigment stones tend to develop in people
limits the amount of food a person can who have
eat or digest—lead to rapid weight loss
and increased risk of gallstones. • cirrhosis—a condition in which the liver
slowly deteriorates and malfunctions
• Diet. Research suggests diets high due to chronic, or long lasting, injury
in calories and refined carbohydrates
and low in fiber increase the risk of • infections in the bile ducts
gallstones. Refined carbohydrates are • severe hemolytic anemias—conditions
grains processed to remove bran and in which red blood cells are continuously
germ, which contain nutrients and fiber. broken down, such as sickle cell anemia
Examples of refined carbohydrates
include white bread and white rice.
• Certain intestinal diseases. Diseases
that affect normal absorption of
nutrients, such as Crohn’s disease, are
associated with gallstones.

3 Gallstones
What are the symptoms and
complications of gallstones?
Many people with gallstones do not have
symptoms. Gallstones that do not cause
symptoms are called asymptomatic, or silent,
gallstones. Silent gallstones do not interfere
with the function of the gallbladder, liver, or
pancreas.
If gallstones block the bile ducts, pressure
increases in the gallbladder, causing a
gallbladder attack. The pain usually lasts
from 1 to several hours.1 Gallbladder attacks
often follow heavy meals, and they usually
occur in the evening or during the night.
Gallbladder attacks usually stop when
gallstones move and no longer block the
bile ducts. However, if any of the bile ducts
remain blocked for more than a few hours,
complications can occur. Complications
include inflammation, or swelling, of the
gallbladder and severe damage or infection
of the gallbladder, bile ducts, or liver.
A gallstone that becomes lodged in the
common bile duct near the duodenum
and blocks the pancreatic duct can cause
gallstone pancreatitis—inflammation of the
pancreas.
Left untreated, blockages of the bile ducts or
pancreatic duct can be fatal.
4 Gallstones
When should a person talk
with a health care provider
about gallstones?
People who think they have had a gallbladder
attack should notify their health care
provider. Although these attacks usually
resolve as gallstones move, complications can
develop if the bile ducts remain blocked.
People with any of the following symptoms
during or after a gallbladder attack should
see a health care provider immediately:
• abdominal pain lasting more than
5 hours
• nausea and vomiting
• fever—even a low-grade fever—or chills
• yellowish color of the skin or whites of
the eyes, called jaundice
• tea-colored urine and light-colored
stools
These symptoms may be signs of serious
infection or inflammation of the gallbladder,
liver, or pancreas.
How are gallstones
diagnosed?
A health care provider will usually order
an ultrasound exam to diagnose gallstones.
Other imaging tests may also be used.
• Ultrasound exam. Ultrasound uses
a device, called a transducer, that
bounces safe, painless sound waves
off organs to create an image of their
structure. A specially trained technician
performs the procedure in a health care
provider’s office, outpatient center, or
hospital, and a radiologist—a doctor
who specializes in medical imaging—
interprets the images. Anesthesia is not
needed. If gallstones are present, they
will be visible in the image. Ultrasound
is the most accurate method to detect
gallstones.
• Computerized tomography (CT) scan.
A CT scan is an x ray that produces
pictures of the body. A CT scan may
include the injection of a special dye,
called contrast medium. CT scans use
a combination of x rays and computer
technology to create three-dimensional
(3-D) images. CT scans require the
person to lie on a table that slides
into a tunnel-shaped device where the
x rays are taken. An x-ray technician
performs the procedure in an outpatient
center or hospital, and a radiologist
interprets the images. Anesthesia is not
needed. CT scans can show gallstones
or complications, such as infection
and blockage of the gallbladder or bile
ducts. However, CT scans can miss
gallstones that are present.
5 Gallstones
• Magnetic resonance imaging (MRI).
MRI machines use radio waves and
magnets to produce detailed pictures
of the body’s internal organs and
soft tissues without using x rays. A
specially trained technician performs
the procedure in an outpatient center
or hospital, and a radiologist interprets
the images. Anesthesia is not needed,
though people with a fear of confined
spaces may receive light sedation. An
MRI may include the injection of
contrast medium. With most MRI
machines, the person lies on a table
that slides into a tunnel-shaped device
that may be open ended or closed at
one end; some newer machines allow
the person to lie in a more open space.
MRIs can show gallstones in the ducts
of the biliary system.
• Cholescintigraphy. Cholescintigraphy—
also called a hydroxyl iminodiacetic
acid scan, HIDA scan, or hepatobiliary
scan—uses an unharmful radioactive
material to produce pictures of the
biliary system. In cholescintigraphy,
the person lies on an exam table and
a health care provider injects a small
amount of unharmful radioactive
material into a vein in the person’s
arm. The health care provider may
also inject a substance that causes
the gallbladder to contract. A special
camera takes pictures of the radioactive
material as it moves through the biliary
system. A specially trained technician
performs the procedure in an outpatient
center or hospital, and a radiologist
interprets the images. Anesthesia is not
needed. Cholescintigraphy is used to
diagnose abnormal contractions of the
gallbladder or obstruction of the bile
ducts.
 • Endoscopic retrograde
cholangiopancreatography (ERCP).
ERCP uses an x ray to look into the
bile and pancreatic ducts. After lightly
sedating the person, the health care
provider inserts an endoscope—a small,
flexible tube with a light and a camera
on the end—through the mouth into
the duodenum and bile ducts. The
endoscope is connected to a computer
and video monitor. The health care
provider injects contrast medium
through the tube into the bile ducts,
which makes the ducts show up on the
monitor. The health care provider
performs the procedure in an outpatient
center or hospital. ERCP helps the
health care provider locate the affected
bile duct and the gallstone. The stone
is captured in a tiny basket attached to
the endoscope and removed. This test
is more invasive than other tests and is
used selectively.
Health care providers also use blood tests to
look for signs of infection or inflammation
of the bile ducts, gallbladder, pancreas, or
liver. A blood test involves drawing blood at
a health care provider’s office or commercial
facility and sending the sample to a lab for
analysis.
Gallstone symptoms may be similar to those
of other conditions, such as appendicitis,
ulcers, pancreatitis, and gastroesophageal
reflux disease.
Sometimes, silent gallstones are found when
a person does not have any symptoms. For
example, a health care provider may notice
gallstones when performing ultrasound for a
different reason.
6 Gallstones
How are gallstones treated?
If gallstones are not causing symptoms,
treatment is usually not needed. However,
if a person has a gallbladder attack or other
symptoms, a health care provider will usually
recommend treatment. A person may be
referred to a gastroenterologist—a doctor
who specializes in digestive diseases—
for treatment. If a person has had one
gallbladder attack, more episodes will likely
follow.
The usual treatment for gallstones is
surgery to remove the gallbladder. If a
person cannot undergo surgery, nonsurgical
treatments may be used to dissolve
cholesterol gallstones. A health care
provider may use ERCP to remove stones
in people who cannot undergo surgery or to
remove stones from the common bile duct
in people who are about to have gallbladder
removal surgery.
Surgery
Surgery to remove the gallbladder, called
cholecystectomy, is one of the most common
operations performed on adults in the
United States.
The gallbladder is not an essential organ,
which means a person can live normally
without a gallbladder. Once the gallbladder
is removed, bile flows out of the liver through
the hepatic and common bile ducts and
directly into the duodenum, instead of being
stored in the gallbladder.
Surgeons perform two types of To perform an open cholecystectomy,
cholecystectomy: the surgeon creates an incision about
4 to 6 inches long in the abdomen to
• Laparoscopic cholecystectomy. In
remove the gallbladder.4 Patients
a laparoscopic cholecystectomy,
usually receive general anesthesia.
the surgeon makes several tiny
Recovery from open cholecystectomy
incisions in the abdomen and inserts
may require some people to stay in
a laparoscope—a thin tube with a tiny
the hospital for up to a week. Normal
video camera attached. The camera
physical activity can usually be resumed
sends a magnified image from inside
after about a month.3
the body to a video monitor, giving
the surgeon a close-up view of organs A small number of people have softer and
and tissues. While watching the more frequent stools after gallbladder
monitor, the surgeon uses instruments removal because bile flows into the
to carefully separate the gallbladder duodenum more often. Changes in bowel
from the liver, bile ducts, and other habits are usually temporary; however,
structures. Then the surgeon removes they should be discussed with a health care
the gallbladder through one of the provider.
small incisions. Patients usually receive
Though complications from gallbladder
general anesthesia.
surgery are rare, the most common
Most cholecystectomies are performed complication is injury to the bile ducts. An
with laparoscopy. Many laparoscopic injured common bile duct can leak bile
cholecystectomies are performed on an and cause a painful and possibly dangerous
outpatient basis, meaning the person is infection. One or more additional
able to go home the same day. Normal operations may be needed to repair the bile
physical activity can usually be resumed ducts. Bile duct injuries occur in less than
in about a week.3 1 percent of cholecystectomies.5
• Open cholecystectomy. An open
cholecystectomy is performed when
the gallbladder is severely inflamed,
infected, or scarred from other
operations. In most of these cases,
open cholecystectomy is planned from
the start. However, a surgeon may
perform an open cholecystectomy when
problems occur during a laparoscopic
cholecystectomy. In these cases,
the surgeon must switch to open
cholecystectomy as a safety measure for
the patient.

7 Gallstones
Nonsurgical Treatments for Eating, Diet, and Nutrition
Cholesterol Gallstones Factors related to eating, diet, and nutrition
Nonsurgical treatments are used only in that increase the risk of gallstones include
special situations, such as when a person
• obesity
with cholesterol stones has a serious medical
condition that prevents surgery. Gallstones • rapid weight loss
often recur within 5 years after nonsurgical • diets high in calories and refined
treatment.6 carbohydrates and low in fiber
Two types of nonsurgical treatments can be People can decrease their risk of gallstones
used to dissolve cholesterol gallstones: by maintaining a healthy weight through
• Oral dissolution therapy. Ursodiol proper diet and nutrition.
(Actigall) and chenodiol (Chenix) are Ursodiol can help prevent gallstones in
medications that contain bile acids people who rapidly lose weight through
that can dissolve gallstones. These low-calorie diets or bariatric surgery. People
medications are most effective in should talk with their health care provider or
dissolving small cholesterol stones. dietitian about what diet is right for them.
Months or years of treatment may be
needed to dissolve all stones.
• Shock wave lithotripsy. A machine
called a lithotripter is used to crush the
gallstone. The lithotripter generates
shock waves that pass through the
person’s body to break the gallstone
into smaller pieces. This procedure is
used only rarely and may be used along
with ursodiol.

8 Gallstones
 Points to Remember
• Gallstones are hard particles that
develop in the gallbladder.
• Imbalances in the substances that
make up bile cause gallstones.
Gallstones may form if bile contains
too much cholesterol, too much
bilirubin, or not enough bile salts.
Scientists do not fully understand why
these imbalances occur.
• Women, people over age 40, people
with a family history of gallstones,
American Indians, and Mexican
Americans have a higher risk of
developing gallstones.
• Many people with gallstones do not
have symptoms. Gallstones that
do not cause symptoms are called
asymptomatic, or silent, gallstones.
• If gallstones block the bile ducts,
pressure increases in the gallbladder,
causing a gallbladder attack.
• Gallbladder attacks often follow heavy
meals, and they usually occur in the
evening or during the night.
• Gallstone symptoms may be similar to
those of other conditions.
9 Gallstones
• If gallstones are not causing
symptoms, treatment is usually not
needed. However, if a person has a
gallbladder attack or other symptoms,
a health care provider will usually
recommend treatment.
• The usual treatment for gallstones
is surgery to remove the gallbladder.
If a person cannot undergo
surgery, nonsurgical treatments
may be used to dissolve cholesterol
gallstones. A health care provider
may use endoscopic retrograde
cholangiopancreatography (ERCP) to
remove stones in people who cannot
undergo surgery or to remove stones
from the common bile duct in people
who are about to have gallbladder
removal surgery.
• The gallbladder is not an essential
organ, which means a person can live
normally without a gallbladder. Once
the gallbladder is removed, bile flows
out of the liver through the hepatic
and common bile ducts and directly
into the duodenum, instead of being
stored in the gallbladder.
Hope through Research 3. Sherwinter DA. Laparoscopic
cholecystectomy. Medscape website.
The Division of Digestive Diseases and
http://emedicine.medscape.com/
Nutrition at the National Institute of
article/1582292-overview. Updated
Diabetes and Digestive and Kidney Diseases
May 10, 2013. Accessed July 23, 2013.
(NIDDK) supports basic and clinical
research into gastrointestinal diseases, 4. Hope WW. Open cholecystectomy.
including gallstones. Medscape website. http://emedicine.
medscape.com/article/1582261­
Clinical trials are research studies involving
overview#showall. Updated January 8,
people. Clinical trials look at safe and
2013. Accessed July 23, 2013.
effective new ways to prevent, detect, or
treat disease. Researchers also use clinical 5. Sahajpal AK, Chow SC, Dixon E, Greig
trials to look at other aspects of care, such PD, Gallinger S, Wei AC. Bile duct
as improving the quality of life for people injuries associated with laparoscopic
with chronic illnesses. To learn more about cholecystectomy: timing of repair and
clinical trials, why they matter, and how to long-term outcomes. Archives of Surgery.
participate, visit the NIH Clinical Research 2010;145(8):757–763.
Trials and You website at www.nih.gov/health/
6. Portincasa P, Ciaula AD, Bonfrate
clinicaltrials. For information about current
L, Wang DQ. Therapy of gallstone
studies, visit www.ClinicalTrials.gov.
disease: what it was, what it is, what it
will be. World Journal of Gastrointestinal
References Pharmacology and Therapeutics.
1. Heuman DM. Cholelithiasis. Medscape 2012;3(2):7–20.
website. http://emedicine.medscape.
com/article/175667-overview#showall.
Updated May 13, 2013. Accessed
July 23, 2013.
2. Stinton LM, Shaffer EA. Epidemiology
of gallbladder disease: cholelithiasis
and cancer. Gut and Liver.
2012;6(2):172–187.

10 Gallstones
For More Information You may also find additional information about this
topic by visiting MedlinePlus at www.medlineplus.gov.
American College of Gastroenterology
This publication may contain information about
6400 Goldsboro Road, Suite 200 medications and, when taken as prescribed,
Bethesda, MD 20827 the conditions they treat. When prepared, this
Phone: 301–263–9000 publication included the most current information
available. For updates or for questions about
Fax: 301–263–9025 any medications, contact the U.S. Food and Drug
Email: info@acg.gi.org Administration toll-free at 1–888–INFO–FDA
Internet: www.gi.org (1–888–463–6332) or visit www.fda.gov. Consult your
health care provider for more information.
American Gastroenterological Association
4930 Del Ray Avenue
Bethesda, MD 20814
The U.S. Government does not endorse or favor any
Phone: 301–654–2055 specific commercial product or company. Trade,
Fax: 301–654–5920 proprietary, or company names appearing in this
Email: member@gastro.org document are used only because they are considered
necessary in the context of the information provided.
Internet: www.gastro.org If a product is not mentioned, the omission does not
mean or imply that the product is unsatisfactory.

Acknowledgments
Publications produced by the Clearinghouse
are carefully reviewed by both NIDDK
scientists and outside experts. This
publication was reviewed by Michael G. Sarr,
M.D., Mayo Clinic.

11 Gallstones
National Digestive Diseases
Information Clearinghouse
2 Information Way
Bethesda, MD 20892–3570
Phone: 1–800–891–5389
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: nddic@info.niddk.nih.gov
Internet: www.digestive.niddk.nih.gov
The National Digestive Diseases Information
Clearinghouse (NDDIC) is a service of the
National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK). The
NIDDK is part of the National Institutes of
Health of the U.S. Department of Health
and Human Services. Established in 1980,
the Clearinghouse provides information
about digestive diseases to people with
digestive disorders and to their families,
health care professionals, and the public.
The NDDIC answers inquiries, develops and
distributes publications, and works closely
with professional and patient organizations
and Government agencies to coordinate
resources about digestive diseases.

This publication is not copyrighted. The Clearinghouse

encourages users of this publication to duplicate and
distribute as many copies as desired.
This publication is available at
www.digestive.niddk.nih.gov.

NIH Publication No. 13–2897

September 2013

The NIDDK prints on recycled paper with bio-based ink.